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Nursing Homes Administer Psych Drugs For No Reason

Oct 27, 2009 | Parker Waichman Alonso LLP

The Chicago Tribune broke with an expose on how some powerful psychotropic medications are being administered to nursing home residents in Illinois without consent and without valid psychiatric diagnoses. Some of these elderly have suffered from a variety of adverse responses that include, said the Tribune, “tremors, dangerous lethargy, and a higher risk of harmful falls or even death.”

Psychotropic medications include antipsychotics, antidepressants, and anti-anxiety medications, explained the Tribune.

According to the Tribune, it found 1,200 violations affecting 2,900 patients since 2001, all involving pychotropics; however, it is believed that the figures are higher given the dearth of regular investigations. According to the Tribune, some sites only inspect once every 15 months, and generally only conduct spot checks.

Psychotropic drugs have been administered for a wide array of seemingly pointless reasons, for instance one woman because she would not wear a bra, a man for being “easily annoyed," a blind woman for "yelling out" and being "easily annoyed," another woman due to "her inability to perform her personal hygiene," and another woman for being "nasty." The Tribune looked through tens of thousands of state and federal inspection reports involving everything from "five-star" to run-down facilities.

Some nursing home residents do suffer from the types of “major mental illness” that warrant antipsychotic medications; however, many of the patients administered these medications did not have a diagnoses of psychosis and some were so delicate and frail that they required an oxygen tank to breathe, said the Tribune.

Researcher Christie Teigland, is looking at the data on some 275,000 nursing home residents who have been diagnosed with dementia, said the Tribune. Teigland has found that those patients taking psychotropic drugs were likelier to fall or deteriorate versus other patients and, when taken off the medications, tended to improve.

Dr. David Graham, a U.S. Food and Drug Administration (FDA) scientist, speaking before congress two years ago, said that he estimated that there are thousands of nursing home resident fatalities annually over antipsychotics being administered unnecessarily and to patients who are not diagnosed with any mental illness. Of note, said the Tribune, these types of medicines can be very dangerous and many carry the FDA’s strongest warnings—the black-box warnings. Side effects from antipsychotic medications include significant “lethargy, permanent involuntary muscle movements, seizures and sudden death,” said the Tribune.

Until 1987, there were little regulations regarding sedating nursing home residents; however, although a law was enacted then to protect residents from unneeded medications, the dosing still occurs, said the Tribune. And, while such facilities are prohibited from administering pychotropics without a prescription, patient’s consent, and “justification,” the Tribune inspection found that this is not always the case.

In its review of 742 Illinois nursing homes, most—at least two-thirds—were cited for incidents involving psychotropic medications at least once in an eight-year period, said the Tribune. Of these, said the Tribune, dozens were cited yearly and some had added a bogus mental illness diagnosis to patient files. Sadly, the Tribune found, some patients were prescribed the medications to ameliorate some symptoms while underlying issues—the Tribune noted pain or infection as just two—went untreated.